(HealthDay News) — In a clinical practice guideline published online in the Journal of Clinical Oncology, recommendations are presented for the management of patients with small renal masses (SRMs).

Antonio Finelli, MD, from the Princess Margaret Cancer Center in Toronto, and colleagues provide recommendations for management of patients with SRMs. Data were reviewed from 83 studies, including 20 systematic reviews and 63 primary studies.

The authors note that when the results may alter management, all patients with an SRM should be considered for a biopsy, on the basis of tumor-specific findings and competing risks of mortality. For patients with significant comorbidities and limited life expectancy, active surveillance should be an initial management option. Partial nephrectomy (PN) is the standard treatment for SRMs and should be offered to all patients with indication for an intervention and who have a tumor suited for this approach. If complete ablation can reliably be achieved, percutaneous thermal ablation should be considered. Radical nephrectomy should be reserved for patients with a tumor of significant complexity that is not suited to PN or for whom PN may result in unacceptable morbidity even when performed at centers with expertise.

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“Given our current understanding of the natural history of SRMs, studies are required to more accurately characterize these lesions beyond histopathology such that the true metastatic potential can be appreciated and guide management decisions,” the authors write.

Several authors disclosed financial ties to the biopharmaceutical industry.

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  1. Finelli A, Ismaila N, Russo P. Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice Guideline. J Oncol Pract. 24 January 2017. doi: 10.1200/JOP.2016.019620 [Epub ahead of print]